Microsurgical Reconstruction of the Left Gastric Artery Using the Middle Colic Artery to Avoid Ischemic Gastropathy: A Report of Three Cases

Abstract

In recent years, advancements in surgical procedures and perioperative management have improved cancer treatments, thereby expanding surgical indications for pancreatic cancer treatment. In distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer, the left gastric artery (LGA) , which is the main feeding vessel of the stomach, may be dissected with the celiac artery. As a result, there is a high possibility of ischemic gastropathy due to decreased blood flow in the stomach. In order to avoid ischemic gastropathy after DP-CAR, a retrospective study was conducted on three cases in which the LGA was reconstructed with the middle colic artery (MCA) . In all cases, intraoperative indocyanine green angiography revealed sufficient blood flow to the stomach wall. Postoperative contrast-enhanced computed tomography did not demonstrate stenosis or occlusion of the vascular anastomosis, and ischemic gastropathy was not observed. In DP-CAR, reconstruction of the LGA with the MCA may prevent postoperative ischemic gastropathy.